Current Approach to Undifferentiated Headache Management in the Emergency Department

Rashed, Amir; Mazer‐Amirshahi, Maryann; Pourmand, Ali

doi:10.1007/s11916-019-0765-1

Cited by 4 publications

(3 citation statements)

References 121 publications

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“…The studies evaluated in this review did not indicate neuroimaging during the diagnosis of primary headaches. These results are corroborated by two systematic reviews [31,32], one of them conducted by members of the American College of Emergency Physicians (ACEP) [31]. However, it has been indicated that primary headache frequently leads to unnecessary tests and imaging.…”

Section: Discussionmentioning

confidence: 79%

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

Medina¹,

González‐Arroyave²,

Angel³

et al. 2023

Cureus

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This systematic scoping review aims to answer questions related to the main characteristics of primary headache, the need for neuroimaging, and the presence of red flags in these patients. A review of prospective studies including the MEDLINE/PubMed, Scopus, LILACS, and SCIELO databases, as well as the grey literature, was conducted. The methodological quality of the selected investigations was also assessed. Six investigations met the selection criteria. The mean age of people with primary headache was less than 43 years, with ages ranging from 39 to 46 years. Most of the studies reported the presence of nausea/vomiting, between 12% and 60% of the patients studied. To a lesser extent, there was also the presence of intense and moderate pain, loss of consciousness, stiff neck, presence of aura, and photophobia. The most frequent diagnoses were unspecified headache, migraine, and tension headache. The studies did not recommend neuroimaging and no red flags were reported. Primary headache occurred more frequently in women, in those under 46 years of age with a history of migraine and similar episodes. Moreover, the presence of red flags and the need for neuroimaging in patients with primary headaches were not evidenced.

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Section: Discussionmentioning

confidence: 79%

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

Medina¹,

González‐Arroyave²,

Angel³

et al. 2023

Cureus

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“…A further review by Naeem et al [ 38 ] in 2018 reported that although there is evidence for the use of ketamine in the management of migraine, it does not translate to primary HA patients. In 2019, Rashed et al [ 39 ] stated that ketamine is best reserved for use in patients who are refractory to other first-line and second-line treatments. It should be noted that in three retrospective studies on chronic refractory migraines and new daily persistent headaches, positive results were shown in those cohorts of patients using ketamine infusions [ 18 27 40 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Chah

Jones

Milord

et al. 2021

J Dent Anesth Pain Med

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Background Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

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“…It is important to note that the timing of migraine treatment is critical, as pathophysiology and therapies vary between the prodromal phase with aura (vasospasm) and the headache phase (vasodilation), where ketamine shows good efficacy [244]. While more studies are needed to fully understand the use of ketamine in analgesic dosing for the treatment of headaches, the initial results are interesting because they offer an additional therapeutic option [245,246].…”

Section: − Headachementioning

confidence: 99%

Narrative Review: Low-Dose Ketamine for Pain Management

Riccardi¹,

Guarino

Serra

et al. 2023

JCM

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Pain is the leading cause of medical consultations and occurs in 50–70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia. In this narrative review, ketamine’s role as an analgesic is discussed, with both known and new applications in various contexts (acute, chronic, and neuropathic pain), along with its strengths and weaknesses, especially in terms of psychomimetic, cardiovascular, and hepatic effects. Moreover, new scientific evidence has been reviewed on the use of additional drugs with ketamine, such as magnesium infusion for improving analgesia and clonidine for treating psychomimetic symptoms. Finally, this narrative review was refined by the experience of the Pain Group of the Italian Society of Emergency Medicine (SIMEU) in treating acute and chronic pain with acute manifestations in Italian Emergency Departments.

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Current Approach to Undifferentiated Headache Management in the Emergency Department

Cited by 4 publications

References 121 publications

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Narrative Review: Low-Dose Ketamine for Pain Management

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